Individual
MS. KIM LOUISE LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
18802 COUNTY 39, BAGLEY, MN 56621-4906
(218) 657-2316
Mailing address
18802 COUNTY 39, BAGLEY, MN 56621-4906
(218) 657-2316
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102598
MN
Other
Enumeration date
02/28/2011
Last updated
02/28/2011
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